Cyclosporine use only with specialist risk benefit assessment
Obstetric involvement
Early obstetrics consult
Delivery planning only for obstetric indications
Geriatric
Geriatric considerations
Higher risk profile
Comorbidity burden
Frailty and limited reserve
Medication considerations
Renal dosing adjustments for supportive meds
Increased delirium risk with opioids and sedatives
Prognostication
SCORTEN age factor increases mortality risk category
Pediatrics
Pediatric considerations
Differential emphasis
Staphylococcal scalded skin syndrome common mimic
Mycoplasma induced rash and mucositis consideration
Fluids
Urine output target 1 mL/kg/hour
Weight based resuscitation with close electrolyte monitoring
Medication dosing
Analgesia weight based dosing and monitoring
Immunomodulating therapy only with pediatric dermatology and ICU
Background
Epidemiology
Epidemiology facts
Incidence
SJS incidence approximately 1.2 to 6.0 per million person years
TEN incidence approximately 0.4 to 1.2 per million person years
Mortality spectrum
SJS mortality approximately 5 percent in large inpatient datasets
TEN mortality higher and varies by severity and comorbidity
Demographics
Risk increases with age
Female predominance reported in multiple cohorts
Pathophysiology
Mechanism overview
Immune mediated keratinocyte apoptosis
Cytotoxic T cell and NK cell involvement
Fas FasL and granulysin pathways implicated
Barrier failure consequences
Fluid loss similar to burn physiology
Electrolyte derangements
High infection susceptibility
Mucosal injury consequences
Ocular scarring risk
Oral intake failure risk
GU synechiae risk
Therapeutic Considerations
Treatment rationale
Supportive care is cornerstone
Outcomes improve with specialized multidisciplinary care
Burn unit style supportive care often used
Immunomodulation uncertainty
Systemic therapies show inconsistent efficacy across studies
Early timing may matter
Antibiotic stewardship
Infection is common cause of death
Prophylactic antibiotics not routinely recommended
Patient Discharge Instructions
copy discharge instructions
Discharge messaging set
If SJS TEN diagnosis not confirmed
Clear explanation of working diagnosis and uncertainty
Explicit medication avoid list until specialist review
Return immediately to ER for red flags
New or worsening fever
Skin pain worsening
New blisters or peeling skin
Eye pain
Vision changes
Mouth sores limiting drinking
Trouble breathing
Chest pain
Fainting or severe weakness
Decreased urination
Follow up plan if discharged for alternative diagnosis
Dermatology follow up within 24 to 72 hours
Ophthalmology follow up if any eye symptoms
Primary care medication review within 48 hours
Medication safety
No new medications unless prescribed after review of reaction risk
Avoid self starting NSAIDs or antibiotics without clinician guidance
References
Clinical guidelines and evidence sources
Key sources
UK guidelines for management of SJS TEN in adults 2016 British Association of Dermatologists
Creamer D et al Br J Dermatol 2016
Summary document BAD SJS TEN two page treatment summary
SCORTEN criteria summary
Merck Manual Professional Edition table SCORTEN
DermNet NZ SCORTEN criteria listing
Systemic treatment evidence synthesis
Chang HC et al 2022 systematic review and meta analyses summary in PMC
Cochrane Review systemic interventions for SJS TEN 2022
Epidemiology data
Klimas N et al 2015 review with incidence ranges in PMC
Wasuwanich P et al 2023 inpatient outcomes and mortality in PMC
Supportive care practice reference
Emergency Care BC clinical summary SJS TEN treatment
Source instructions
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.